Tailor-made heart simulation predicts the effect of cardiac resynchronization therapy in a canine model of heart
Nirmal Panthee1, Jun-ichi Okada2, Takumi Washio2
1Department of Cardiac Surgery, School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan.
Insights
Cardiac resynchronization therapy (CRT) simulations using patient-specific 3D heart models accurately predict treatment effectiveness. This approach helps optimize pacing lead placement for improved outcomes in heart failure patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Computational Biology
Background:
- Cardiac resynchronization therapy (CRT) is used for heart failure but has a 30% non-response rate.
- Current selection criteria for CRT do not fully predict patient response.
- Left bundle branch block (LBBB) is a common indication for CRT.
Purpose of the Study:
- To evaluate the predictive capability of 3D heart model simulations for CRT response.
- To determine if individualized electromechanical models can guide optimal lead placement.
- To validate simulation predictions in a canine heart failure model.
Main Methods:
- Created individualized 3D heart models from CT scans in 4 canine LBBB models.
- Performed CRT simulations for 25 ventricular pacing lead positions.
- Validated simulation predictions through acute pacing experiments.
Main Results:
- Significant correlations found between simulated and observed ejection fraction (EF) improvements (P<0.01).
- Simulations accurately predicted optimal and worst pacing lead positions.
- Individualized models predicted hemodynamic improvements effectively.
Conclusions:
- 3D heart model simulations can predict acute hemodynamic improvement from CRT.
- This simulation approach aids in determining optimal pacing lead positioning.
- Individualized modeling offers a promising tool to enhance CRT efficacy.
Abstract:
Despite extensive studies on clinical indices for the selection of patient candidates for cardiac resynchronization therapy (CRT), approximately 30% of selected patients do not respond to this therapy. Herein, we examined whether CRT simulations based on individualized realistic three-dimensional heart models can predict the therapeutic effect of CRT in a canine model of heart failure with left bundle branch block. In four canine models of failing heart with dyssynchrony, individualized three-dimensional heart models reproducing the electromechanical activity of each animal were created based on the computer tomographic images. CRT simulations were performed for 25 patterns of three ventricular pacing lead positions. Lead positions producing the best and the worst therapeutic effects were selected in each model. The validity of predictions was tested in acute experiments in which hearts were paced from the sites identified by simulations. We found significant correlations between the experimentally observed improvement in ejection fraction (EF) and the predicted improvements in ejection fraction (P<0.01) or the maximum value of the derivative of left ventricular pressure (P<0.01). The optimal lead positions produced better outcomes compared with the worst positioning in all dogs studied, although there were significant variations in responses. Variations in ventricular wall thickness among the dogs may have contributed to these responses. Thus CRT simulations using the individualized three-dimensional heart models can predict acute hemodynamic improvement, and help determine the optimal positions of the pacing lead.
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